Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy

Q: What are the key findings of this study?

Cardiac MRI demonstrated that late gadolinium enhancement was present in only 5% of athletes compared to 57% of HCM, 56% of ARVC, and 44% of DCM patients.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Athlete's heart, Hypertrophic cardiomyopathy (HCM), Arrhythmogenic right ventricular cardiomyopathy (ARVC), Dilated cardiomyopathy (DCM) (n=120). Intervention: Cardiac MRI vs. Cardiomyopathy patients (HCM, ARVC, DCM). Primary outcome: Presence of late gadolinium enhancement (LGE) (p=<0.0001).

Jens Kübler; Christof Burgstahler; Jan M. Brendel; Sebastian Gassenmaier; Florian Hagen; Karin Klingel; Susann-Cathrin Olthof; K. G. Blume; Bernd Wolfarth; Karin Anne Lydia Mueller; Simon Greulich; Patrick Krumm

doi:10.1007/s10554-021-02280-6

May 21, 2021International journal of cardiac imagingOpen Access

Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy

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Key result

Cardiac MRI detects LGE in only ~5% of athletes versus HCM, ARVC, and DCM patients.

P<0.0001
n=120

Figures

Why the study?

Can cardiac MRI morphological and functional parameters differentiate athlete's heart from hypertrophic, arrhythmogenic right ventricular, and dilated cardiomyopathies?

Study Design

Type

Cross-Sectional (n=120)

Multicenter

Yes

Structured PICO

Can cardiac MRI morphological and functional parameters differentiate athlete's heart from hypertrophic, arrhythmogenic right ventricular, and dilated cardiomyopathies?

P

Population

120 subjects, comprising 40 healthy top-level Caucasian athletes (mean age 24, 68% male) and 80 patients with cardiomyopathies (14 with hypertrophic cardiomyopathy [HCM], 18 with arrhythmogenic right ventricular cardiomyopathy [ARVC], and 48 with biopsy-proven dilated cardiomyopathy [DCM]).

O

Outcome

Differentiation of athlete's heart from cardiomyopathies using cardiac MRI morphological and functional parameters (including LVEDVI, EF, RV-EF, myocardial thickness, and late gadolinium enhancement).surrogate

Main Result

Absolute Event Rate: 5% vs 57%

p-value: p=<0.0001

Cardiac MRI reveals that while athlete's hearts show hypertrophy and dilation, the absence of late gadolinium enhancement and preserved wall motion help differentiate them from pathologic cardiomyopathies.

Limitations

Only Caucasian national top-level athletes were examined
Cardiomyopathy patients were retrospectively enrolled while athletes were prospective
Significant difference in age between athletes and cardiomyopathy patients
Investigates only one time point in athletes, so dynamic changes could not be included
No clinical data, ECG findings, or family history were included in the evaluation
Athletes were investigated prospectively, whereas cardiomyopathy patients were retrospectively enrolled
Investigates only one time point in athletes and dynamic changes could not be included
No clinical data, ECG findings, or family history included in the evaluation

Implication

Absence of LGE on CMR may support differentiation of athlete's heart from HCM/ARVC/DCM; hypothesis-generating and requires prospective validation.

Abstract

; p = 0.001). Mean LV ejection fraction (EF) was 61% in athletes, below normal in 7 (18%) athletes vs. EF 29% in DCM, below normal in 46 (96%) patients (p < 0.0001). Mean RV-EF was 54% in athletes vs. 60% in HCM, 46% in ARVC, and 41% in DCM (p < 0.0001). Mean interventricular myocardial thickness was 10 mm in athletes vs. 12 mm in HCM (p = 0.0005), 9 mm in ARVC, and 9 mm in DCM. LGE was present in 1 (5%) athlete, 8 (57%) HCM, 10 (56%) ARVC, and 21 (44%) DCM patients (p < 0.0001). Healthy athletes' hearts are characterized by both hypertrophy and dilation, low EF of both ventricles at rest, and increased interventricular septal thickness with a low prevalence of LGE. Differentiation of athlete's heart from other non-ischemic cardiomyopathies in MRI can be challenging due to a significant overlap of characteristics also seen in HCM, ARVC, and DCM.

Discussion

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Cite This Study

Kübler et al. (2021) conducted a cross-sectional in Athlete's heart, Hypertrophic cardiomyopathy (HCM), Arrhythmogenic right ventricular cardiomyopathy (ARVC), Dilated cardiomyopathy (DCM) (n=120). Cardiac MRI vs. Cardiomyopathy patients (HCM, ARVC, DCM) was evaluated on Presence of late gadolinium enhancement (LGE) (p=<0.0001). Cardiac MRI demonstrated that late gadolinium enhancement was present in only 5% of athletes compared to 57% of HCM, 56% of ARVC, and 44% of DCM patients.

synapsesocial.com/papers/6a0514d26c3d07813971be5b https://doi.org/10.1007/s10554-021-02280-6

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Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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